Individual provider Active NPI

Christian Lama Medina, RPT

  • Physical Therapist
  • Diamond Bar, CA
National Provider Identifier
1104913789
Registry record updated Jul 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT29198 Issued in CA
Practice address
832 N Diamond Bar Blvd
Diamond Bar, CA 91765-1039
Phone
(909) 861-8211
Fax
(909) 861-8055
NPI assigned
Oct 6, 2006
Last updated
Jul 18, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT29198 CA Primary

Addresses

Primary practice location

832 N Diamond Bar Blvd
Diamond Bar, CA 91765-1039

Mailing address

832 N Diamond Bar Blvd
Diamond Bar, CA 91765-1039
Phone (909) 861-8211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT29198CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
NK Rehab Inc Physical Therapist CurrentSince Jun 3, 2013 Accepting new patients
Christian Lama Medina Physical Therapy, Inc. Physical Therapist PastSince Oct 16, 2006 Accepting new patients

Locations

830 N Diamond Bar Blvd
Diamond Bar, CA 91765
Phone (909) 861-8211

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374105600000",
    "number": "1104913789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "832 N DIAMOND BAR BLVD",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917651039",
            "telephone_number": "909-861-8211",
            "fax_number": "909-861-8055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "832 N DIAMOND BAR BLVD",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917651039",
            "telephone_number": "909-861-8211",
            "fax_number": "909-861-8055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "CHRISTIAN",
        "middle_name": "LAMA",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2013-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT29198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Diamond Bar, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.